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Letting Nature Take Its Course

driedleaf.jpgI learned the phrase “let nature takes its course” late in the game when helping my parents. For those of us who are trying to advocate for a loved one’s wishes, this is a powerful statement to know especially when you are dealing with the medical community.

Most members of the medical community are trained to help sustain or improve life. It took me a while to comprehend why my mom’s assisted living community kept re-initiating vitamins. On a quarterly basis, I would ask to see the medications. Even though they were supposed to contact me BEFORE changing medications, it didn’t always happen and I regularly had to address it. It started when they told me mom was refusing to take the medication she needed that was helping her anxiety, and that was causing a host of other community issues.* When I reviewed her medications, she had a host of daily vitamins. Mom was never a pill-taker, so she was exerting control by refusing to take any pills.

I know that nutrition and vitamins can help with a host of other issues, but I would request at the quarterly review that we discuss the merits of every medication mom was prescribed.

While I (and my siblings) managed through hospice with dad, and then with mom, it wasn’t until she broke her hip that I learned the importance of using this term and for requesting the right consults.

At 84, described medically as frail, and unable to walk on her own, a broken hip is a significant injury. Mom was with her personal care assistant and tried to turn and seemed to fall sideways. Her care assistant caught her before her hip even hit the ground so we didn’t really expect it to be a break. When it turned out to be a break, the aging life care manager I called in for advice suggested that the break happened when mom was turning. It made sense since while she normally bruised at the slightest bump, she didn’t even have a mark on the side where her hip broke.

The choices the orthopedic surgeon offered:

  1. Move her into hospice care with a broken hip;
  2. Remove the Do Not Resuscitate order, put her through surgery to med a broken hip for pain management.

Two totally crappy choices. As soon as they took mom for x-rays, I bent over sobbing knowing that mom was only going to have a few more days or weeks of life. Not the ending anyone wants, but she would finally be able to leave this earth and her dementia behind.

The woman who helped me, Debbie Aggen, RN, CSA, met me in mom’s hospital room and suggested I request a geriatric consult, and use the words “let nature take its course.” The doctor quizzed me a bit on my mom’s wishes, was I sure this is what she wanted? Is this in her medical directives? Thankfully, the answer to both of these was yes.

Mom was too weak to withstand surgery, so our choices became fate. For more than three decades, my mom told me that should she end up like her mother who had memory issues, I was supposed to ‘put a pillow over my head and take me out’. Unfortunately, there are really no options for someone with cognitive issues in the current “right to die” movement.

I never thought this was how it was going to end. Hospice arrived to help us keep mom pain-free while letting nature takes its course. She died on Christmas Day. While it will most likely bring me to tears for years to come, I was relieved I finally helped my mom escape the life with dementia she was living. Granted. 

*There are many schools of thought that with the right care, medication to control behavior would not be needed. However, since she was in a community, we couldn’t control how the other residents with memory issues would interact with mom and she seemed happier when she was taking the medications prescribed. 

6 comments on “Letting Nature Take Its Course

  1. Very familiar with the “let nature take it’s course” philosophy and practiced it with my own mother too. While so hard to do, I felt the same relief you did in the end.

  2. I’ve read before about the end of your mother’s life and the decisions that had to be made and it is still as moving reading about it again.

  3. I am the caregiver for my wife who has Alzheimer’s (age 61) and she is not quite there yet but I had a similar situation with my mother who had dementia and was also on dialysis. We eventually stopped the dialysis and then she fell and broke her hip. We also decided not to do surgery and she passed peacefully. I am a physician and see this all of the time. You made the right decision – more people need to be brave and let nature take its course. You might want to look at my blog as well – http://alzheimershubbydoc.wordpress.com

  4. When we serve as advocates for our loved one’s health, it can be hard to accept that there are times when allowing nature to take its course is the most compassionate choice to make. That doesn’t make the decision any easier, of course, but I agree that with dementia, there is a sense of relief, that they are free of such a terrible disease.

  5. Hard choices I didn’t know what I was doing at the time but I’m sure Brompton’s Cocktail kept my first wife out of pain and let nature take it’s course. Almost 40 years later and I’m the one who fetches additional morphine for Maureen’s daughter as the McMillan Nurses said ‘she’s changing’. Denise wanted to let nature take its course as she had seen a friend a little further on than she was. Two beautiful women who were taken from us well before their time.

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